Dr.

Deepti Bodh

SURGICAL ANATOMY
BOVINE UDDER
The bovine udder comprises of 4 glands, each of which has one principal teat. Udder is divided
into right and left halves by a prominent median intermammary groove. The division between
fore and hind quarters of each side is less distinct. The udder is suspended from the body wall by
strong fascial medial and lateral laminae that together are termed as suspensory apparatus. The
medial lamina is the stronger of the two and is largely made up of elastic tissue. The right and
left medial laminae are separated by a small amount of loose connective tissue, which makes it
possible to remove one half of the udder easily. The lateral lamina is composed of dense
connective tissue. It arises from the area of lateral crus of external inguinal ring and pubic
symphysis and provides protection to the mammary vasculature and superficial inguinal
(mammary) lymph nodes. The laminae are thickest dorsally and become thinner at the ventral
aspect. The bulk of udder is made up of connective tissue mixed with parenchyma. The main
arterial supply is the external pudendal artery with a small contribution made by the mammary
branch of the ventral perineal artery. The external pudendal artery and veins enter the udder
after passing through the inguinal ring. The artery first forms a sigmoid flexure and then divides
into cranial and caudal mammary branches. Cranial branch is large and directed ventrocranially,
while the caudal branch supplies the back of udder. Both vessels branch extensively to supply the
parenchyma. A ring of venous drainage is located above the base of the udder. Venous drainage
is contributed by the external pudendal veins, subcutaneous abdominal (milk) veins, ventral
perineal veins, and udder tributaries. Innervation to udder is from the lumbar spinal nerve (L1,
L2, and the genitofemoral nerve) and scaral spinal nerves (mammary branch of the pudendal
nerve)
Species differences: The udder of small ruminants consists of 2 glands, which vary from conical
and deep in the milking goat to small and spherical in sheep. The structure, suspension, vascular
and nerve supply is similar to that of bovine.
BOVINE TEAT
The bovine mammary gland comprises of 4 quarters with 1 teat each. Teat consists of teat wall,
apex with the streak canal, and teat sinus. Proximally, the teat sinus is continuous with the
corresponding gland sinus. The annular fold/annular ring (venous ring of Furstenberg) separates
the teat sinus from the gland sinus. It contains 1 or more large veins that encircle the base of the
teat.The wall of teat consists of following layers: the innermost layer is lined by mucosa & a
two-layered cuboidal epithelium, followed by submucosa, intermediate layer is formed by the
connective tissue layer (contains numerous large blood vessels that become engorged with blood
during milking and suckling process), and smooth muscle layer (superficial: longitudinal m. +
deep: circular m.) External layer is formed by a stratified squamous epithelium. The streak
canal (teat canal or papillary duct) is lined with stratified squamous epithelium and keratin. It
varies in length from 5 to 10 mm and is located at the apex of teat. It connects teat sinus to the
outside ending at the teat orifice (ostium papillae). The rosette of Furstenberg is the area where
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the stratified squamous epithelium of the streak canal meets the two layered cuboidal epithelium
of teat sinus. It represents the proximal delineation of the streak canal or separates teat sinus
from teat canal. The teat sphincter is located beneath the rosette of Furstenberg and consists of
circularly oriented bundles of smooth muscle fibres. The teat sphincter and keratin limning of
the streak canal are responsible for milk continence and preventing ascending infection.
EXAMINATION OF TEAT
1. Visual inspection: to describe colour, shape, and size of teat and type and location of any
laceration present
2. Careful palpation and rolling of affected teat between thumb and finger to determine any
pain elicited as well as location and size of obstructive tissue present
3. Hand and machine milking to determine milk flow
4. California Mastitis Test or strip test analysis to screen for evidence of mastitis
5. Microbial culture and sensitivity testing of sample from a quarter suspected to be affected
by mastitis
6. Probing the streak canal with a teat probe
7. Probing teat & gland sinus with a side-opening teat cannula for obstructing tissue in area
8. Injecting methylene blue dye into the orifice of a suspected conjoined teat to stain milk
and confirm communication with the primary teat.
9. Ultrasonography, radiography and endoscopy (THELOSCOPY) of teat to visualize size
and location of obstructive tissues present in the teat and gland sinus

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 AFFECTIONS OF THE MAMMARY GLAND
DISEASES OF UDDER AND TEAT ARE DIVIDED INTO THREE MAIN SUBGROUPS
Anomalies of the epithelial surface of the teat
1. Supernumerary or extra teats
2. Fused teats
3. Conjoined or webbed teat
4. Teat lacerations
5. Teat fistula
6. Udder and teat abscess
7. Bovine ulcerative mammilltis (Sore teat)
8. Papilloma & warts
Surgical conditions of teat cistern/gland
1. Lactoliths/milk stone/calculus of teat canal
2. Teat canal polyps
3. Teat spider (membranous obstruction)
4. Teat cistern obstruction or fibrosis of teat canal
Surgical conditions of streak/teat canal/ teat sphincter
1. Contracted sphincter (Hard milker)
2. ‘Enlarged teat orifice (Free milker or teat leaker)
3. Rupture and inversion of streak canal mucosa
4. Occlusion of teat orifice/imperforate teat/blind teat

I. ANOMALIES OF THE EPITHELIAL SURFACE OF THE TEAT

Supernumerary or extra teats
Supernumerary teats are extra teats that may be present anywhere on the udder of cow
(most frequently seen on posterior surface of udder and in-between teat). They may be functional
or nonfunctional. These teats should be removed surgically if they interfere with milking, in
case of increased risk of mastitis, and due to cosmetic reasons. In young animals (3-6 months)
supernumerary teats can be removed with scissors, in animals older than 6 months, emasculator
is used. Surgery is performed under local infiltration analgesia with two elliptical incisions at the
junctions of teat and udder and skin wound closed with interrupted suture using nonabsorbable
suture material.
Fused teat
The skin of two adjacent teats is fused together from the base without any involvement of
teat canal or muscles. Surgery involves division of skin in between fused teats and suturing of
cutaneous wound under local anaesthesia.

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Conjoined or webbed teat
A conjoined teat is defined as a supernumerary teat attached to the side of a primary teat.
These teat have their own accessory glands. They may either be seen as a bulge at the proximal
aspect of primary teat or as an extra teat orifice at its side. Surgical removal is necessary as they
interfere with milking and there is also increased incidence of mastitis in the accessory gland
which may spread to primary gland in future.
Open teat lacerations
Laceration of teat is mostly seen in animals having long teats and pendulous udder.
Direct injury, trauma inflicted by barbed wire fences, thorny bushes and agricultural implements
cause deep lacerations.
Teat lacerations can be open lacerations or have skin integrity preserved. Open teat lacerations
are classified as partial or full thickness lacerations that perforate into the streak canal, teat
sinus, or gland sinus.
In full thickness lacerations, a three-layer closure that involves submucosa, intermediate layer
(connective tissue+ smooth muscles) and skin is involved. Submucosa and intermediate layer are
opposed separately with a continuous horizontal mattress suture that does not perforate the
mucosa using 4-0 monofilament synthetic resorbable suture material with a taper point swaged-
on needle. Skin is closed with simple interrupted sutures using 3-0 or 4-0 monofilament suture
material with a reverse cutting swaged on needle.
Partial thickness lacerations are repaired in a similar fashion, but here the submucosa is not
involved.
Post operative care:
1. Passive milk drainage every second day
2. Intramammary antimicrobials every 4-10 days.
Teat fistula
Teat fistula is an abnormal accessory opening on the teat that communicates with the
primary teat sinus or teat canal. It can be congenital but usually results from a full thickness teat
laceration and occurs as a complication of secondary wound healing or dehiscence after primary
healing. Clinical signs include presence of fistulous tract and milk coming out from it during
milking. Cases of teat fistula are considered as emergency because any delay in repair of such
teat will cause development of mastitis or necrosis of the teat.
Rx:
Methylene blue dye injected through a fistula appears in the milk of the main teat.
Small fistula: mild chemical cauterization
Large fistula: Repaired under deep sedation, local anaesthesia and ring block
A full coverage of systematic antibiotic is required and for proper drainage Larson’s teat plug is
used. Different suture techniques are used to repair the teat fistula but double layer simple
continuous suturing with PGA 3/0 and in between simple vertical mattress simple interrupted
suturing of skin with nylon 1/0 is found suitable for repair of teat fistula

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Mucosa: simple interrupted or continuous suture + absorbable suture material + atraumatic
needle
Submucosa and muscularis: simple continuous suture pattern
Skin: simple interrupted or vertical mattress sutures using absorbable or non-absorbable suture
material
Two techniques for repair of teat fistula in a cow:
Moussu’s method: The edges of teat fistula are freshened and are sutured by a set of mattress
sutures passing through the skin and subcutis on one edge and only subcutis on the other edge.
Another layer of interrupted sutures are applied and a teat siphon is introduced and bandaged.
Gold’s method: Following freshening of the fistula a series of mattress sutures are placed
through the muscular and skin of either side without piercing the mucous edge.
Bovine ulcerative mammilitis (Sore teats)
The teats become painful due to presence of crackes, traumatic injuries, lesions due to
disease conditions such as bovine herpes virus II & IV, pox, FMD etc. If these lesions are not
treated well in time, the animal will not allow touching the affected teat for milking. These
lesions become ulcers in due course of time and the condition is then known as bovine ulcerative
mammilltis. Oozing of blood from the injured teat causes contamination of milk while milking
thereby making it unfit for human consumption. In such cases, sterilized teat siphon should be
used to drain the milk out. For treatment of such painful lesions, the wound is washed with light
potassium permanganate solution and then soothing preparation such as iodized glycerin,
bismuth iodoform paraffin paste, zinc oxide ointment or antiseptic dressing with soothing
emollient is continued till complete healing of the lesion occurs.
Udder and teat abscess
Abscess formation occurs more often on the udder than the teat. Many cases with
chronic mastitis especially due to resistant microbes suddenly develop abs cessation on the side
of affected udder. Such cases can easily be diagnosed by puncturing the swollen part. The
abscess cavity is opened for complete drainage of pus. The cavity is dressed with tincture iodine
followed by application of soothing agents until obliteration of abscess cavity. In case of necrosis
of teat or udder, amputation of teat or affected quarter is recommended followed by daily
dressing till complete healing of wound occurs.
Papillomas or Wart
These are finger like projections present on the skin surface of the teat. They may be
single or multiple. They do not interfere with milking but may cause pain when they are
ulcerated. Rx: A tight ligature is applied at the base of the wart that occludes the blood supply,
necrosis occurs causing the wart to drop off

II.SURGICAL CONDITIONS OF TEAT CISTERN/GLAND

Lactolith or milk stones or calculus of the teat canal
Milk stones are formed in the teat canal when milk is rich in minerals and salty in taste
due to super saturation of salts. The stone moves freely in the teat canal and hinder the milk flow,
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if large in size. Careful manual palpation of the teat or ultrasonography reveals firm, round,
movable, object and probing the teat canal reveals it to be a concretion. They usually get washed
out along with milk but if large in size then it can be crushed with small alligator forceps or
cutting the sphincter with litchy teat knife or teat bistouries and milked out
Teat canal polyp
Polyps are small pea sized growths attached to the wall of teat cistern or teat canal.
Polyps hinder the milking process and sometimes even block the passage of teat canal. Teat
polyps can easily be taken out by Hug’s teat tumor extractor, a curette or a teat polyp extractor. If
its location is above the teat canal, then thelotomy is the best method for resection of excessive
tissue.
Teat spider or membranous obstruction
The condition usually results due to congenital absence of teat cistern or canal. It can be
acquired in cases of injury, tumor or inflammation of mammary tissue resulting in formation of
thin or thick, partial or complete membrane, situated either at the base of teat or middle of teat or
lower down in the cistern. Palpation shows fluctuating milk above the obstruction but milking is
not possible. If the obstruction is congenital and the membrane is too thick, the quarter is allowed
to atrophy and become non-functional. If the obstruction is acquired and pocket of milk can be
felt, then prognosis after treatment is good. Under local anaesthesia, teat is prepared for surgery.
If the membrane is thin, it is divided into four by introducing a concealed teat knife or Hudson’s
teat spiral through the teat canal or the membrane can be slit in 3 or 4 directions using a small
teat bistoury. Successful removal of the membrane through surgical incision through the base of
teat can also be attempted. Affected quarter should not be milked completely to avoid stricture.
Teat cistern obstruction or fibrosis of teat canal
Commonly observed in lactating animals where a hard fibrous cord like structure is
present in the teat. Repeated trauma due to mechanical injuries, thumb milking and calf suckling
are the main contributory factors. Sometimes mastitis can also result into fibrosis of quarter
followed by teat canal. The fibrotic cord obstructs the teat canal and creates hindrance during
milking. In such cases, initially hot water fomentation followed by counter irritant massage with
iodine ointment and turpentine liniment is useful. If the fibrotic nodule is present on the tip of the
teat, it can be removed by Hugs teat tumor extractor. If the growth is larger than nodule but
occupies < 30 % of teat cistern, then thelotomy (open teat surgery) is performed. If the growth
occupies > 30% of teat cistern, then silicon prosthesis is used.
Fibrosis of the gland sinus
Normal gland tissue is replaced by connective tissue. It can either be congenital or is seen
after infection of gland sinus before first lactation or during dry period. Palpation of affected
mammary gland reveals diffuse induration. Prognosis for return to milk production is hopeless.
Tumor of mammary gland
These are infrequently in lactating animals however, fibroadenoma reported in heifer.
The growth can be surgically removed under caudal block or local infiltration analgesia.

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III. SURGICAL CONDITION OF STREAK CANAL or TEAT SPHINCTER
Teat stenosis or Contracted sphincter or hard milker
Contracted sphincter occurs due to stenosis of streak canal as a result of repeated trauma
resulting in hard milking of teat. During milking one has to apply more force to take the milk out
and milk will come out in fine stream. Overdeveloped sphincter muscles, small diameter of
streak canal, acute and chronic inflammation as a result of trauma may also cause difficulty in
milking.
Rx:
1. Give anti-inflammatory drugs: to treat acute inflammation
2. Place Larson’s tube in the teat canal to remove milk
3. If the constriction of sphincter is at the terminal portion of teat, then it is incised using a
Stensen’s or conical teat dilator. A constriction higher up in the teat canal is cut using a
Litchy teat knife or a teat bistoury or a concealed teat knife. Several cuts are made into
the duct rather than single cut.
4. Stenosis of streak canal without acute inflammation can be treated successfully by
incising the sphincter in three directions with teat knife, Bard parker blade No.11,
McLean teat knife
5. Larson’s teat tube or a polyethylene catheter is placed through the teat orifice and
retained for 5-7 days
6. Intramammary antibiotics should be infused postoperatively
Enlarged teat orifice or free milker or teat leaker
This condition is just reverse of teat stenosis. It can be due to direct injury or relaxation or
excessive surgical enlargement of teat sphincter in case of a hard milker. In this case milk will go
on leaking and sometimes infection may gain entry leading to mastitis. This condition is treated
by injection of small amount (0.25 ml) of Lugol’s iodine around the orifice or scarification and
suturing with one or two stitches with monofilament nylon.
Rupture and inversion of streak canal mucosa
The mucosa of the streak canal gets ruptured circularly and gets inverted into the teat
cistern. The detached mucus membrane is removed surgically via thelotomy
Occlusion of teat orifice or Imperforate teat or blind teat
This is a congenital deformity wherein the teat canal has no external opening. It may be
acquired due to any trauma near the teat sphincter. In such cases milk is present in the teat cistern
down to teat sphincter but cannot be forced from the teat. Rx: Imperforated teat is treated by 15
gauze needle, after creating an artificial opening, it is further dilated using Hugs teat tumor
extractor, a milk canula is fixed for 24 hour, after that frequent milking advised at 4 to 6 hours
intervals to prevent adhesion. Administration of antibiotics is done for 3-5 days.
• Theilitis- Inflammation of the teats
• Mastitis- Inflammation of mammary gland or udder

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SURGICAL INTERVENTIONS OF UDDER AND TEAT
Teat amputation: Indicated when teat damage caused by severe trauma is irreversible
Udder ablation/ Mammary gland amputation: Rarely used in cows and buffaloes
Indications:
1. Severe mastitis refractory to treatment, 2. Gangrenous mastitis (goats), 3. Suppurative
mastitis, 4. Malignant diseases of udder, 5. When there is breakdown of supporting
ligaments of a large pendulous udder and, 6. If there are no other means of salvaging
animal’s productivity, this may be used
Blood supply:
1. External pudic artery & vein (entering through the base of gland at its middle)
2. Perineal artery & vein (posterior aspect)
3. Subcutaneous abdominal vein or milk vein ( anterior aspect of gland)
Nerve supply:
1. Inguinal nerves (anterior & posterior), 2. Sympathetic nerves, and 3.Cutaneous nerves
originating from ventral branches of L1, L2 and L3 and T13 nerves
Procedure: Major blood vessels supplying udder are doubly ligated and transfixed with a non-
absorbable suture. Skin incision is started on midline, posteriorly near the base of udder and
extended along the base to its anterior aspect. The incision should leave a sufficient skin flap to
cover that half of ventrum from which the udder is removed. Skin flaps are closed to cover
surgical area after udder removal. The skin is reflected dorsally away from the glandular tissue
and body wall. A division is apparent in this area, and the gland is separated from the body wall
posteriorly, and medially to locate the area adjacent to external inguinal ring. Major blood
vessels located in this area are doubly ligated. The separation of this half of udder is continued
anteriorly until the perineal and subcutaneous abdominal vessels are also located and ligated. The
suspensory ligament supporting this half of udder is severed near body. After removal of all the
glandular tissue, skin flaps are sutured closely to cover the surgical field.
THELOTOMY (open teat surgery)
THELOSCOPY: Is a diagnostic and surgical procedure used for removing obstructive tissues in
the area of the rosette of Furstenberg with minimal surgical trauma to the teat.
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